Relating to vision benefit plans, vision benefit managers, vision care providers, and vision care provider contracts and including civil penalties and effective date and applicability provisions

This bill relates to vision benefit plans, vision benefit managers, vision care providers, and vision care provider contracts. The bill details the standards of conduct for vision benefit managers (managers), including the requirements for a reimbursement paid by a manager to a vision care provider (provider), annual increases in reimbursement rate fee schedules, the period of time for a manager to recover a reimbursement amount from a provider, the auditing time frame for an audit of a claim or a collection of a claim, a reimbursement for a covered service or covered material provided to a covered person, the identification of participating providers, and the licensure requirements for managers. “Covered person”, “vision benefit manager”, and “vision care provider” are defined in the bill. A manager shall not engage in any of the conduct prohibited by the bill. A contract between a manager and a provider shall not violate the provisions of the bill. A manager shall comply with the national association of insurance commissioners coordination of benefits regulations, and the coordination of benefits shall allow for a covered person to apply all benefits to the cost of a covered service and covered material. Under the bill, for the acquisition or merger of managers, the parties to the acquisition or merger shall provide for a reenrollment period for providers. The reenrollment process and details must be well defined and provide for a minimum of six months notice to providers prior to the activation of a new plan by the prevailing manager after the merger or acquisition. During the merger or acquisition, a provider shall be entitled to opt out of reenrollment without penalty or obligation to the previous contract. The prevailing manager to the merger or acquisition shall enter into updated contracts with all providers who choose to reenroll. A provider adversely affected by a violation of the bill by a manager may bring an action in a court of competent jurisdiction for injunctive relief against the manager. If a provider prevails in such action, in addition to injunctive relief, the provider shall be entitled to recover monetary damages, penalties not to exceed $10,000 for each violation, and attorney fees and costs. The attorney general may bring an action on behalf of a provider for injunctive relief against a manager. The bill applies to policies, contracts, and plans between a manager and a provider delivered, issued for delivery, continued, or renewed in this state on or after the effective date of the bill. The bill also applies to an affiliate or subcontractor used by a manager to supply covered services or covered materials to a provider or a covered person. The commissioner of insurance may adopt rules to administer the bill.3(2). The bill takes effect upon enactment.